| National Provider Identifier [NPI]: | 1861611816 |
| Last Name Of The Provider | JOHNSON |
| First Name Of The Provider | RANDON |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1431 N WESTERN AVE |
| Street Address 2 Of The Provider | #310 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 606221797 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 847 |
| Number Of Medicare Beneficiaries | 160 |
| Total Submitted Charge Amount | 238328.95 |
| Total Medicare Allowed Amount | 90031.93 |
| Total Medicare Payment Amount | 69535.57 |
| Total Medicare Standardized Payment Amount | 62424.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 435 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 7296 |
| Total Drug Medicare AllowedAmount | 1039.41 |
| Total Drug Medicare PaymentAmount | 814.99 |
| Total Drug Medicare Standardized Payment Amount | 814.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 69 |
| Number Of Medical Services | 412 |
| Number Of Medicare Beneficiaries With Medical Services | 160 |
| Total Medical Submitted Charge Amount | 231032.95 |
| Total Medical Medicare Allowed Amount | 88992.52 |
| Total Medical Medicare Payment Amount | 68720.58 |
| Total Medical Medicare Standardized Payment Amount | 61609.41 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 41 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 107 |
| Number Of Male Beneficiaries | 53 |
| Number Of Non Hispanic White Beneficiaries | 38 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 96 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 49 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 111 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5186 |